Provider Demographics
NPI:1952388688
Name:SPROAT, DAVID BRECKENRIDGE (MD, MSA, FAAFP)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRECKENRIDGE
Last Name:SPROAT
Suffix:
Gender:M
Credentials:MD, MSA, FAAFP
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:ALLEN
Other - Last Name:SPROAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:509 CAMINO LOS ALTOS
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-8331
Mailing Address - Country:US
Mailing Address - Phone:505-930-6080
Mailing Address - Fax:
Practice Address - Street 1:2050A 2ND ST SE
Practice Address - Street 2:
Practice Address - City:KIRTLAND AFB
Practice Address - State:NM
Practice Address - Zip Code:87117-5901
Practice Address - Country:US
Practice Address - Phone:505-846-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68002207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine